Healthcare Provider Details

I. General information

NPI: 1417568924
Provider Name (Legal Business Name): JANA PEARL GALAMBOS JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 POPLAR AVE APT M1
MURFREESBORO TN
37129-2473
US

IV. Provider business mailing address

PO BOX 10443
MURFREESBORO TN
37129-0009
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-5483
  • Fax:
Mailing address:
  • Phone: 626-765-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number122330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: